Finding Text
U.S. Department of Health and Human Services
Passed through the NC Department of Health and Human Services
Program Name: Medical Assistance Program (Medicaid; Title XIX)
AL #: 93.778
Finding: 2023-010 Inaccurate Resources Entry
SIGNIFICANT DEFICENCY
Eligibility
Criteria:
Condition:
Questioned Costs:
Context:
Effect:
Cause:
Identification of a repeat
finding:
Recommendation:
Views of responsible
officials and planned
corrective actions:
There were 1 errors discovered during our procedures that resources in the county
documentation and those same resources contained in NC FAST were not the same amounts
or files containing resources were not properly documented to be considered countable or
non-countable.
There was no known affect to eligibility and there were no known questioned costs.
We examined 60 cases from of a total of 804,789 Medicaid claims from the Medicaid
beneficiary report provided by NC Department of Health and Human Services to redetermine
eligibility. These findings are being reported with the financial statement audit as
it relates to Medicaid administrative cost compliance audit.
For those certifications/re-certifications there was a chance that information was not
properly documented and reconciled to NC FAST and a participant could have been
approved for benefits for which they were not eligible.
In accordance with Medicaid Manual MA-2230, Medicaid for Aged, Blind and Disabled
case records should contain documentation that verifications were done in preparation of the
application and these items will agree to reports in the NC FAST system. In this process,
the countable resources should be calculated correctly and agree back to the amounts in the
NC FAST system. Any items discovered in the verification process should be considered
countable or noncountable resources and explained within the documentation.
Section III. Federal Award Findings and Questioned Costs (continued)
Ineffective record keeping and ineffective case review process, incomplete documentation,
and incorrect application of rules for purposes of determining eligibility.
This is a repeat finding from the immediate previous audit, 2022-006.
The County agrees with the finding.
Files should be reviewed internally to ensure proper documentation is in place for
eligibility. Workers should be retrained on what files should contain and the importance of
complete and accurate record keeping. We recommend that all files include online
verifications, documented resources of income and those amounts agree to information in
NC FAST. The results found or documentation made in case notes should clearly indicate
what actions were performed and the results of those actions.